As with many surgical interventions, access to Inspire hypoglossal nerve stimulation therapy for sleep apnea is determined not just by clinical need but by insurer eligibility thresholds. When diagnostic integrity falters, the criteria that central apneas must account for less than 25% of all events can become a barrier. I experienced a case in which a patient’s diagnosis was misclassified as central sleep apnea, thereby not meeting payor guidelines for an Inspire implant.